The Big Oversight In Our Obesity Conversation

It didn’t take long for the year’s first controversial health study to go viral. A new systematic review and meta-analysis published in the Journal of the American Medical Association (JAMA) concluded that carrying extra weight decreases the risk of death (those in the “overweight” category were six percent less likely to die than individuals at a “normal weight”). This is a stark contrast to the usual weight-related headlines, which identify excess weight as the root cause of various chronic diseases. Cue confusion and heated debates.

I consider myself in the middle of both of those camps and also outside, standing at a completely different vantage point. Labeling increased rates of overweight and obesity in the United States as a “myth” is inaccurate and dangerous. When a highly visible public health issue is dismissed as a fairy tale, conversation is stifled. Concurrently, the health field’s obsession with obesity has reached a fanatical fever pitch, with troubling consequences. You may remember last year’s “obesity is the enemy and it’s going to kill us all!” headlines after the Robert Wood Johnson Foundation released the statistic that by 2030, adult obesity rates could be as high as 60 percent in 13 U.S. states. Much like the JAMA study, that grim prediction went viral within minutes. Tellingly, though, this wasn’t viewed as a controversial headline, but rather accepted as reality (and, sadly, the “Americans just need to get off their couches!” comments soon followed).

Here is where my vantage point differs, and what I believe to be a crucial point missing from this debate. When our discussions on health center around weight (whether by stressing or minimizing the dangers of gaining it), it is too easy to leave other important factors out of the conversation. In the case of the JAMA study, for instance, little was stated about the quality of life of these heavier individuals who live longer than people with lower Body Mass Index (BMIs). Roughly one-third of Americans aged between the ages of 57 and 85 take at least five prescription medications a day (many of those for diet-related conditions like hypertension and high cholesterol). Is living longer worth it if it means holding our bodies and wallets hostage to Big Pharma?

Studies that only consider excess weight as a health risk also don’t reflect my years of experience as a dietitian in various settings (from hospitals and long-term care facilities to corporate wellness and schools). I have worked with hundreds of patients, and have encountered plenty of “normal weight” individuals with poor diets who had high blood pressure and high triglycerides, as well as several overweight individuals who ate healthfully, had perfect numbers and felt healthy.

My biggest concern is that solely focusing on weight (regardless of how positive or negative that focus is) impedes the health movement’s progress. Such a clinical and quantitative frame gives very little thought to – and leaves no room for a conversation about – socio-political and environmental factors that pose a threat to our health (including, but not limited to industry lobbying, Big Food predatory marketing, and misguided agricultural subsidies). Even if the message is “being overweight isn’t bad for your health,” we do know that a highly processed diet (let’s face it, the Standard American Diet) is. There is no doubt that, above all else, the way we eat has tremendous effects on our health.

This point of view matters because it is precisely the neutral and apolitical focus on weight that has contributed to our current public health mess. When health is only discussed through a lens of weight, it is easy for the food industry to consider itself part of the dutiful troops, whether it’s with “commitments to physical activity” or reduced-calorie, minimally nutritious processed foods that feature artificial sweeteners and “fat replacers” made from genetically modified corn. After all, if the goal is simply to get someone to lose 15 pounds, then a 100-calorie snack pack of Cheetos should “do the trick,” as should a diet soda.

I urge my fellow colleagues – especially those in public health and nutrition – to not get trapped in the “obesity is the problem” mold. The framework of obesity can be useful to talk about other issues, such as the fact that obesity maps in the United States are a mirror image of maps of concentrated poverty and food deserts. Obesity is as much a socioeconomic and political issue as it is a public health one, and that is important piece of the puzzle that is often forgotten about. And, above all, regardless of whether it turns out that a BMI of 26 is “healthier” than a BMI of 24 or not, let’s remember that weight is not necessarily a reflection of health.

To those who criticize the JAMA study and insist that obesity is the problem to solve – I pose this question: If obesity is “the problem,” then what is the solution? A population that is of normal weight? I won’t deny that some medical and health risks increase with obesity, but it is possible to be at a “healthy weight,” while subsisting on minimally nutritious foods. Let’s also remember the growing body of evidence which demonstrates that one’s fitness level is much more important than weight alone. And, furthermore, if the ultimate goal is a population that is not overweight or obese, then let’s use that as an opportunity to have a meaningful conversation about, for instance, how to fix the food environment.Until we can have a national conversation about health – specifically how it is affected by our food systems, environment, and politics – instead of weight, it will be hard to make the case for sound policy that promotes our well-being, regardless of our numbers on the scale.

One problem with the attack on obesity instead of promoting healthy eating is the reduction of portion size in school lunches. I have a skinny and very active grandson and those portions are just not enough!

I hate to play devils advocate, because I certainly agree with everything you discuss, but we are not all health/nutrition enthusiasts and it is necessary to frame the obesity discussion with something that is easily understood (weight, BMI) for the rest of the population. I know BMI and similar measures are not perfect, but they provide 'tangible' measures of our health and allow the large majority of the population to understand the potential consequences of their eating behaviors and the potential benefit of lifestyle modifications. I also recognize that improving our food environment is probably the best way to encourage change and improve the health and nutrition of the most people, but who should be in charge of such a task and at what point do regulatory agencies become too big and start infringing upon our basic freedoms?

I honestly believe that changes to our food environment need to be accompanied by measures to educate consumers on the impact of their food decisions while encouraging them to make the best choices for the physical and mental health. Empowering consumers with a better understanding of nutrition is probably the most important measure we can take in creating sustainable, healthy change.

I haven't read this study, so I can't comment on it specifically, but I do see a problem with many of the diet/health related studies being done. Too many of them isolate 1 issue, while ignoring the big health picture.

Diet, activity levels, stress levels, and much more play into how healthy an individual is. To pin-point just aspect, like BMI, doesn't do much other than generate controversial headlines. It gets too easy to pick and choose the studies that make excuses for questionable life choices.

I would also add that there are environmental consequences to overconsumption. No matter how overconsumption influences our personal health, there are global repercussions we cannot ignore (to animals, farmers, water, air, land, etc).

My view is that we should be talking about a Metabolic Syndrome Epidemic. This deals with the normal weight people who have the symptoms of metabolic syndrome and high weight people who don't. It also points to clearer solutions as we understand better how to reverse metabolic syndrome than we understand how to generate long term weight loss, especially on a population level.

I see the population wide weight gain over the last few decades as a symptom of the Metabolic Syndrome Epidemic rather than the other way around.

Terrific article and valuables comments. I work on what I consider to be the front line of this issue...I teach "Healthy Foods" at the Junior High level. This is the age where many kids are open to new ideas if presented exactly right, that is, geared to their cultural perspective. In teaching this course (in many incarnations) over 15 years, I've evolved, and so have my students. This past semester, I've done more with whole (plant) foods than ever before, and honestly am surprised at just how receptive my students have been.

I am sorry (or not) but statements like this do get me a bit upset: "[...]carrying extra weight decreases the risk of death (those in the “overweight” category were six percent less likely to die than individuals at a “normal weight”)."
That's pretty shoddy writing to me. Because what you say is that overweight people are 6 % less likely to die! That's actually really cool, if I am overweight I have a 6% better chance will live forever? Doh!

Another statistic proofs that breathing during pregnancy is causing Alzheimers. It was found that 100% of people who suffer from Alzheimer had mothers who were breathing at any one stage during their pregnancy.